Medical equipment donations enable hospitals in developing countries to get their hands on expensive and much-needed technology. But there’s a growing concern that those donations do more harm than good. Hallways and closets often become cluttered with unused or broken-down equipment for which locals lack parts or training in how to make repairs. Outdated electrical systems groan under the strain of large medical devices, possibly compromising a hospital’s power.
“I think there is a great risk for every medical device donation that it’s going to hurt the recipient,” says Robert Malkin, a professor of the practice of biomedical engineering at Duke University.
Recently, a study of seven hospitals in Haiti found only 30 percent of the 115 pieces of medical equipment donated after the 2010 earthquake were working and 14 percent of the equipment could not be repaired. The study also found that some donated devices, such as incubators for premature babies, could never work in the hospitals, because they required a higher electrical voltage than is standard in Haiti.
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The World Health Organization (WHO) estimates (pdf) that as much as 80 percent of medical equipment in some countries is donated or funded through foreign sources, but only 10 percent to 30 percent of the donations are ever put into operation. “There is no question that you can donate effectively,” Malkin says, adding the caveat that it takes a lot of effort to make sure everything is done right. For example, Malkin says organizations need to know what recipient hospitals or countries need. They also need to ensure the recipients have access to the right accessories and supplies to make the devices work properly. People need to be trained to use the equipment. And, of course, it also has to be shipped, delivered and installed. “That’s a lot of things to get right, and you need to do that with every piece of equipment,” he says.
Addressing the problem
Currently, WHO spells out the four principles of a good medical equipment donation (pdf): respect the recipient’s request; assure the donation will benefit the recipient; keep an open line of communication; and ensure quality. Malkin is part of the group tasked with rewriting those principles, which have not been updated since 2000. “We’ve tried to shift a lot more responsibility to the recipient,” Malkin says. Hospitals and medical centers requesting medical equipment donations would be expected to make sure they can repair the devices and get spare parts, he adds. Some countries have already stepped in to put a stop to donations of used medical equipment and devices from other countries. For example, some don’t allow incubators nor x-ray and dialysis machines to be shipped to their hospitals.
But Malkin says even new medical device donations come with risks for recipients, including not having access to the right spare parts such as the correct operating-room lightbulbs. “These are not trivial parts to find,” he notes. Instead, he says his organization, Engineering World Health (EWH), which works to improve care at hospitals in the developing world, has stopped shipping a lot of equipment overseas. “In EWH we feel that it’s more powerful to train the staff of the hospital to fix the equipment they have. So we ship very little new equipment,” he says.
Rwanda’s trial run
In 2009 EWH went to Rwanda to start training hospital technicians to manage, fix and maintain medical equipment. “We don’t have biomedical engineering courses in our universities or in our colleges,” says Didier Mukama, country director for EWH in Rwanda. “This was the first time there was formal academic training done here in Rwanda.”
Before EWH came to Rwanda technicians only handled electrical and plumbing problems, Mukama says. When medical equipment broke, hospitals would just request a new donation from another organization. “Basic things like the inventory of medical equipment were not even done, because most of the medical technicians didn’t even know the name of the equipment,” he says.
Malkin and his colleagues, who have been following the effect of the training on hospitals, says they’ve seen the amount of out-of-service equipment fall by almost half, and the technicians’ productivity more than double. Mukamasays the goal is for EWH to train two technicians from each of the country’s public hospitals. Several have already graduated, and dozens are still in training. “I’m really happy with what has been achieved,” he adds. “Before most of the technicians were not even allowed to touch the equipment, but now they are able to do most of the troubleshooting.”
Still, not everything is perfect. Mukamasays there are devices in disrepair because technicians have trouble finding spare parts. “I think the big elephant in the room that nobody had really figured out is spare parts,” Malkin says.
Aside from on-the-ground training, Malkin says he also attends medical technology conferences to present EWH’s work. Currently, about 130 organizations send medical equipment overseas, he says. Some have adopted responsible practices. “I think we’re making some progress,” he adds.
